Viewpoint

The sociological eye means looking at things for what they are, as best we can given the blinders of interest and ideology, of cliché and ritualized belief. It is not an individual enterprise. Chaining our efforts together as a long-term network of theorists and researchers improves one’s own sociological vision, provided we make the effort. The sociological eye holds up a periscope above the tides of political and intellectual partisanship, spying out the patterns of social life in every direction.

Saturday, July 25, 2015

Everything in the human world has
four aspects. They are easy to remember by putting them in four boxes:

The ECONOMIC box: This is a
short-hand for the ways in which things are material, practical, or economic.

The POLITICAL box: Again a
short-hand, for everything that involves power and conflict.

The SOCIAL box: the ways that
people interact with each other, especially their emotions, rituals, and
networks.

The CULTURAL box:people’s ideas and ideals about what
they are doing.

Everything human has these four
requisites.If one or more is
missing, the thing will fail.

Success requires all four in the
right amounts. What are the right amounts? We shall see.

Analyze anything: some examples

The four boxes can be applied to
anything.Using the four-box
scheme is like playing a game of tic-tac-toe or Sudoku.But it is completely serious: away to analyze anything that people are
concerned about, from high politics to low entertainment.

To show what you can do with it,
consider the kinds of kids that everyone who has gone to an American high
school knows about.

Politics has the same
sub-divisions:

Now to put the 4 REQS to work.
Filling in the four boxes for any activity shows what it needs for success and
where are its dangers of failing.

Success and failure in medicine

The CULTURE box:The ideals of medicine are to provide
health and cure sickness. Medical professionals swear to uphold ideals of
service and altruism. The culture of medicine includes doctrines about what
causes illness and the scientific methods for dealing with it. This is the
textbook definition of medicine.

How large does the ideology of
medicine loom in the experience of a patient, or a medical doctor, nurse, or
hospital employee? How important is for whether medicine succeeds or fails?

The ECONOMICS OF MEDICINE box:

The material and practical aspect
of medicine starts from the fact that human bodies are handled by medical
workers. A hospital is a lot like a factory. As in an assembly line, patients
are interviewed, tested for body signs, have specimens drawn, sent to labs,
seen by various specialists, have medicines hooked up or ingested, and are
subjected to various body-intrusive procedures. In the mean time they are
wheeled around from one place to another, moved into rooms when available,
parked in hallways, and sometimes fed and cleaned. The more bodies there are
moving through the medical factory, the more the fate of any one patient is
affected by the sheer quantity of things in the assembly line.

Even the minor experience of how
long you wait between the time you show up for your appointment and the time
you actually see a doctor is determined by how many patients are scheduled and
how long each one takes. The doctor may in fact be quite personable and try to
treat each patient as an individual; but this has the effect that patients
later in the queue end up waiting even longer. The large-scale bureaucratic
side of the organization runs against the ideology of caring, so that many
patients’ experience of a hospital visit is about as people-friendly as a Kafka
novel.

Where patients undergo more
extensive hospital procedures, one’s body rolling around on the gurney is not
very different from an automobile part in a car factory, except that in
factories the supply parts can’t complain about where they are stored; and
hospitals can’t use the just-in-time delivery systems that factories use for
off-site storage.In short, the
human experience of being in a hospital comes from being treated like a part in
a not very efficient factory assembly line-- inefficient because humans are
more unpredictable, especially in how long they will take to respond to treatments.
The result is a lot of unaccountable waiting around.

Notice the contrast: the ideology
of scientific/altruistic medicine describes it as its best; one of the things
it omits is what the experience of being one of the bodies moved around in a
hospital is actually like.

There is also the economics of
medicine in the narrower sense: the costs of medical care, billing and
insurance systems, doctors’ payments, administrative and staff costs, the
hospital plant.Many of these run
in vicious feedback loops. Insurance companies’ efforts to keep costs down
leads to an accelerating back-and-forth between hospital staffs and insurers
disputing payments, with a good deal of fanciful accounting on both sides. It
exemplifies the sociological process of escalation and counter-escalation of
conflict. The result of this administrative warfare is that both sides expand
their billing staffs, making administrative costs endlessly rise.Another vicious feedback loop comes
from the scientific culture of medicine:scientific discoveries lead to new and improved treatments, especially
with the expensive diagnostic equipment of recent decades (CAT scans, MRIs,
etc.); the standard of treatment constantly rises and new levels of expense
become normalised, putting more pressure on hospital administrators to add
equipment and simultaneously to find creative ways to pass the cost along to
someone else.

Here again the ideology of
medicine runs against the economics of medicine. In the perfect world of
economists, patients would be informed consumers who could compare prices and
the values they get from various treatments and make their own decisions. In
the real world of medical practice, patients are rarely informed of such
things; typically the hospital or clinic takes the patient’s arrival at the
door as an agreement to pay for whatever treatment the professionals decide to
give, at whatever price they want to charge. The ideology of caring for
patients does not extend to caring for them financially, nor paying attention to
what medical costs can do to their lives.

The POLITICS OF MEDICINE divides
into an external and an internal aspect. External politics involves government
policies and debates, and political movements for and against particular ways
of legislating about medicine. The ideological stridency reached by such
debates today is obvious. Since the politics box includes any kind of conflict,
it also includes law suits over medical malpractice, damages, and religious and
cultural claims: all of which add to the economic and organizational burdens of
medical professionals.

The internal politics of medicine
is more local; it consists in alliances and power struggles over who runs a
hospital; relations between outside doctors or privately owned clinics and
hospitals they staff; and the financial politics of hospital chains,
take-overs, and the usual maneuvers of the corporate world. Here the link
between the pure ideology of medicine as altrustic service and realities of
medical politics becomes so remote as to have virtually nothing to do with each
other.

Finally, the SOCIAL RELATIONS OF
MEDICINE:How do people interact
with each other? Patients and staff may try to keep up a pleasant, humane
relationship; but the bureaucratic factory setting of medical organization makes
it likely that most interactions are faked. Talking with a doctor or nurse is
the Goffmanian front-stage, since the organizational and economic realities
that the patient is caught up in are rarely even acknowledged. Since patients
have so little power in the system, they try to put up a hopeful front, fearing
that protest will only leave them more neglected in the bureaucratic queue. The
ideology of the helpful, altruistic medical staff and the grateful patient is
constantly strained. Most of their interactions would be considered mediocre
Interaction Rituals, producing little real solidarity.

From the point of view of the
bureaucratic organization, it doesn’t matter what the patients feel, since they
are just the raw material running through the machinery.Hospitals and clinics have developed a
long-standing culture over the years of how to keep patients superficially
quiescent; it used to be called “bedside manner” although now it includes
advertising campaigns and manipulating the decor of waiting rooms. Strictly as
an organization (i.e. the economics box), medicine doesn’t depend on solidarity
with patients.

Lack of solidarity is more of a
threat to relationships within the staff. The biggest problem tends to be the
behavior of the most powerful professionals, the medical doctors. As a strong
profession, they are well-networked among themselves; they can control each
other’s careers by referrals, partnerships, and by word-of-mouth reputation.
These advantages also are useful for economic interests as well, whether
steering patients to expensive procedures from private groups of practitioners,
or manipulating billing practices. Observational studies of hospitals show
doctors who chase gurneys down the hall, briefly asking the patient how they
are doing, then billing it as a full-scale consultation for the insurance
coverage.These kinds of practices
undermine solidarity in the hospital work force as a whole.

How then do we rate medical success or failure?The four boxes have quite different
criteria. From the economic angle, success of a hospital or a medical practice
is how much money it makes; failure would be medical bankruptcy. From the
political angle, success would be a favourable political environment; failure
would be a political swing that crushes the existing medical elite. Most of
reality is in the middle ground of seemingly endless political contention. From
the social angle, the criterion would be patient satisfaction; empirically this
seems to be in the mediocre range.

Finally, there is the lofty ideal
of health and altruistic service. This altruistic side of this seems badly
compromised; what about health? The problem here is that it is a moving
standard. Some diseases have declined; focus on other diseases has risen in
their place. Objectively there is now more scrutiny of medical error (not
unrelated to lawsuits over medical malpractice). Medicine as a whole has been
successful in keeping people alive longer; it also keeps people under medical
treatment longer, not necessarily making them healthier but living more years
when they aren’t healthy.

It has often been cited that any
individual will charge up more in medical costs in the last 6 months before
dying than in the rest of their life. It is the same pattern with automobile
repairs: an old car becomes progressively more expensive to maintain, until the
owner finally decides to get rid of it. These are material realities; the
political, social, and ideological aspects get piled on top and obscure the
reality.

Can’t the success of medicine be
measured objectively, by rating systems? Certainly one sees billboards in every
city across America touting how highly rated a particular local hospital
is.Compared to what? and by what
standard?The naive way to read a
rating system is just to accept the numbers.The more intelligent way-- which takes more work-- is to
look at how the rating was done. By opinion polling among doctors or hospital
administrators? This relies on their gossip network. By objective measures: OK,
which ones? do they measure how satisfied patients are, how favorable their
medical outcomes, how serious their conditions were? The most common objective
measure is of the extremes of failure-- mortality, infection rates, and
complications from medical procedures. This is still only a small part of the
picture.

The overarching problem is there
are four dimensions to the medical system; and they are all unavoidable.
Setting up a rating system for success or failure is itself a matter of
politics, making choices over what to pay attention to and what to ignore. We
are a long way from getting a reliable rating system that tells you which
hospitals give you the best treatment at the best price, with the most pleasant
human interactions.

Looking at the total picture for
all four boxes, it appears that medical systems rarely fail completely, but the
different components undermine each other so much that they rarely work at a
high rate of success. Marshall Meyer and Lynn Zucker referred to these kinds of
organizations as “permanently failing organizations.”How can they go on failing, instead of going out of business
and being replaced by more efficient organizations, as economic theory on its
most abstract level would imagine? In part because medicine is in such high
demand; even permanently failing organizations are better than none at all.

The best practical advance that
sociology can offer is to pull back from the macro level where the four boxes
clash, and focus on the social interaction box. Here are two important findings
by medical sociologists such as Charles Bosk: First, the strongest predictor of
medical failure is whether the patient feels the doctor doesn’t like him or
her. In other words: a genuinely successful interaction ritual between doctor
and patient is the best way to ensure the treatment will be successful. If
there are bad vibes, find another doctor.

Second, medical error is much
lower in Japanese hospitals than in American ones: Why? because in Japan it is
customary for a close relative to always be present in the patient’s room.
Someone who cares personally can monitor whether staff are attentive, and
accidents and oversights are avoided.Hospitals are like factories, and even the most altruistic medical personnel
are worn down by the sheer amount of things they have to do, with rotating
shifts and a constantly changing cast of characters. The bureaucracy of the
hospital can’t be changed; but it can be counter-acted, by adding people into
the situation who have a personal concern for the individual patient.

Success or failure: having a party

The 4 REQS can be applied to
anything. On a lighter note, what does it take to give a successful party?The ideal is for a bunch of people to
assemble, put all their cares aside, and have a good time. This is the CULTURE
box, taken full strength since a party is supposed to be a happy time-out from
everything else. Nevertheless the other three boxes have to be taken care of or
the party will fail.

The ECONOMICS of a party is its
material and practical side, as every party-giver well knows. Where to have the
party; getting your house or venue fixed up; the food, the drinks, the music or
entertainment if any, etc. That is not to say there is much correlation between
how much money and effort is put into the party and how enjoyable it is.There is little research on this
comparison, but there are plenty of instances where very expensive parties fall
flat. One kind of bring-down is where the hosts are too obsessed with the
material side; another is where the guests are too self-conscious about it and
spend their time comparing how lavish things are (or criticizing where they are
not) rather than enjoying themselves.

The POLITICS of a party is where
it overlaps with conflicts and alliances. Putting a collection of people who
don’t like each other in front of a spread of food and drinks will not
necessarily produce a happy occasion. That is why traditional hostesses (as in
the British upper classes) elaborately strategized their dinner parties,
deciding not only who to invite but who to seat next to whom. The shift towards
greater casualness and informality since the latter part of the 20th century
probably has not raised the level of success of social occasions, because this
kind of deliberate concern for whether people will strike it off with each
other has largely disappeared. David Grazian’s research on nightlife shows that
most of the solidarity is confined to little groups of companions who go out
together and make a game out of making any contact at all, however ephemeral,
with the opposite sex.

Stressing the ECONOMICS box can’t
determine whether a party will be successful, although too little attention to
the material input will make it fail.The POLITICS box works the opposite way, where paying a lot of attention
to the right political mix contributes strongly to its success. Invitations
which are too automatic run the likelihood of failure. One familiar version is
the extended-family holiday gathering where the different relatives may not
actually like each other; such gatherings can lead more to conflict than to
collective effervescence.

A techno-solution has become
widespread in modern times: instead of talking, people who have little to say
to each other can all sit and watch TV. Similarly in night clubs extremely loud
music not only sets the atmosphere but is a substitute for conversation.

There is a real historical break
here, since before around 1950, parties and other festive gatherings did not
rely much on conversations. There were traditional ways for getting people
participating together: One was dancing in groups. The last remnant,
line-dancing, goes back to the dance forms prevalent before the mid-1800s,
where men and women maneuvered ceremoniously around the floor in set
formations. Then couples dancing separated people into duos, and introduced a
new element of political status and conflict over who danced with whom and who
was left out. Another participation technique at traditional parties was
playing games; the livelier ones had a lot of physical action, such as hurrying
for chairs that diminished in number when the music stopped. There were also
pretend-games like costume parties; in the 1700s and earlier, the mark of
participating in a festive mood was wearing masks, underscoring the time-out
from ordinary reality of the event.

Not all party games had this level
of collective excitement.Playing
card games was popular since the 1700s. It provided a certain amount of shared
attention, but it reduced the collective effervescence the more seriously it
was treated, as in upper-middle class people playing bridge after dinner, or
masculine gatherings playing poker. The obsessions and conflicts that go along
with gambling can turn the fun-party occasion into a fantasy version of the
POLITICS box.

Finally, the SOCIAL box. This is
the home-ground of a successful party, a state of joyful collective
effervescence, shared by (pretty much) everyone present. The key ingredients,
as in any interaction ritual, are getting everyone focused on the same thing
(something they are all doing together at the party), building up a shared mood
(energy, exuberance, excitement), so that it bubbles over into a shared rhythm.
Individuals at a good party get each other increasingly into the mood.

The other three boxes-- the ideal
of having a party; the material provisions that are consumed; the politics of
how people get along with each other-- all these succeed, or fail, because of
how they affect the collective effervescence. None of the other boxes will
guarantee it;material inputs like
alcohol or other psychotropic substances can affect the energy level, but
drunken people can be boring, sad, or contentious rather than happy.

There is a formula for a truly
successful collective effervescence. New Year’s celebration in Las Vegas is an
example, when people don’t try to say anything significant, just blow your
horns, throw streamers at people, hug people you don’t know. This works where
everyone knows the tradition and throw themselves into it. This contravenes most
of the customs of ordinary life. Everyday life is not like a party because
everyday micro-politics runs counter to what is necessary for widely shared
collective effervescence. That is one reason why successful parties are a
time-out from everyday life. They need special conditions, which can’t be
present all the time. If you insist on making your life one endless party,
there are sure to be times when the party isn’t a very good one.

Try it yourself

You can analyze anything with the
four-requisites model. Religion, education, or family; sports or literature;
sex in any of its varieties; going on vacation. You name it. What is its ideal
of success? What does it need to succeed, and what happens in the other 3 boxes
that makes it fail, or keeps it in a state of conflict? Fill in the boxes:

How much of each requisite is needed? e.g. business start-ups

From the examples given we can see
that different kinds of things have different balances among the requisites.
Any activity needs a minimum in all four boxes, but beyond that which boxes
require the most emphasis depends on what arena you are playing in. It also
depends on timing. For some enterprises, the early period needs a different
mixture of inputs than later periods.

As a sketch, let us consider a
business, during the early period of start-up; when it is established as a
full-blown player; and the late mature phase when the rest of the world has
caught up with it.

POLITICAL box: on the external
side, the state with its political and legal environment, whether supportive or
threatening; on the internal side, the alliances and conflicts that make up its
power structure.

SOCIAL box: Includes both external
and internal networks and how well they are working on the personal level.External networks connect to supply
chain, customers, and recruiting employees. Because the people you do business
with are also potential rivals, and everyone could jump ship in either
direction, whether these networks work successfully or not depends on emotional
flows ranging from mutual enthusiasm to domination to distrust. The same goes
for internal relationships, among fellow employees and in the hierarchy of
control.All this depends on how
successful interaction rituals are.

Which boxes are most important at
which phase of the business’s life-time?

Early start-up stage: The most important factor is in the
CULTUREbox, since the new
business has to establish its identity and name reputation. Economic resources
are going to be needed, but if the owners don’t already have a lot of money,
the key here lies in the SOCIAL box.Economic resources are first built up, not from economic performance,
but from leveraging social networks; above all, that happens by propagating
emotions, so that other people feel a wave of enthusiasm about the new
venture.Compared to this social
outburst, the economic aspect isn’t that important at the beginning. The
POLITICAL box isn’t crucial at the outset either, as long as the start-up stays
out of conflicts, since isn’t big enough to handle them yet.

Established stage:Your reputation, economic position,
organization, supply chains are all established. You know where you fit in the
field of rivals and competitors, and they know it too. All the boxes are
active. The CULTURE box gets less attention, and routine sets in on the SOCIAL
side, especially in the internal organization. The ECONOMIC box tends to get
the most attention. Successful businesses may develop trouble at this stage--
this is what happened to Apple in the early 1980s, after it had mushroomed into
a major corporation, took on managers who made it more similar to the rest of
the field, and eventually brought about big internal conflicts that led to
Steve Jobs’ departure. Failures in the internal POLITICAL box brought them down.

Over-mature stage:Now the rest of the field has caught up
with what you are doing right. Rival firms are all encroaching on each other’s
market niches; global competition over cheaper supply chains is intense. The
most important box becomes the POLITICAL one, including the financial world as
a political realm where coalitions are made and unmade. Pressure comes from
financial markets, and the maneuvers of powerful financiers in raids, buyouts,
campaigns over share-holder value alternatively forcing spin-offs or
acquisitions.The successful
organization at this stage becomes more concerned with external politics than
anything else; even organizations which are highly successful in the other
three boxes can disappear because of the POLITICAL box.

One-sided theories

Most theories in the social
sciences are one-sided, placing all the emphasis on one box.Since all the boxes are important, this
will usually yield some insight. But it leaves the theory with blind spots.

Marxian theory-- once known as
“historical materialism”--places
the prime mover in the economics box. Marxists recognize other boxes exist but regard them as outcomes or screens for economic interests.Ideology is a set of false beliefs,
covering up for the dominant economic interests; ideas themselves are never
autonomous, since they are produced by whoever controls the means of mental
production (churches, schools, the media, etc.) Politics is an arena where
classes struggle for control of the state and the legal system to favor their
own interests. All this has a good deal of reality, and materialists have
discovered some important causal links. Marxian theory is weak especially in
the SOCIAL box. Key processes such as mobilizing political movements, fighting
wars, and the success or failure of revolutions cannot be explained in a purely
Marxian framework, but need theories about interaction rituals, emotions, and
networks.

Economics as a discipline today
has the same location as Marxism. (A rival form, institutional economics,
argues that what happens in markets is shaped by the political and legal environment,
and hence would be located in two boxes.) Rational choice theory in political
science, sociology, and psychology attempts more abstractly to reduce
everything to the dynamics of the economics box.Here again its big flaw is obliviousness to emotional
processes, to the influence of ideas, and to networks that do not resemble
competitive markets.

Structuralist anthropology, and a
related movement of the late 20th century, cultural studies, claims that the
prime mover is the CULTURE box.This claim gains some respectability from theories in cognitive science
that schemas and categories are fundamental in structuring both brains and
computers. For structuralists, the culture/cognitive map lays down the
blue-print on which societies and social institutions are patterned. The
weaknesses of giving primacy to the ideology box are: ignoring the importance
of emotions-- an error that cognitive psychologists have begun to rectify,
since emotions are key markers of what cognitions are paid attention to. There
is also a theoretical dilemma between trapping oneself in a static universe
where culture always repeats itself, and recognizing cultural change but being
unable to explain it except as a mysterious “rupture,” as theorists like
Foucault called it.To explain
changes in culture, the other boxes are needed.

Durkheimian sociology solves these problems by locating primacy in the SOCIAL box.
And it spells out the mechanism by which social solidarity, energy, and action
is generated (and conversely when solidarity, emotion, and action fail).Interaction ritual (IR) theory reverses the
priority between the SOCIAL and the CULTURAL boxes; it is where successful
interaction rituals are carried out that the ideas people focus on and talk
about become sacred objects, thus making them dominant ideas.(Here Durkheim outflanks
Marx.) Why ideologies change is no mystery from this point of view; when the
carriers of ideas stop having successful IRs, those ideas fade away.

Durkheimian theory is one of the
big pieces for solving the whole puzzle, but it can’t stand alone. To carry out
successful IRs, material conditions are needed; so it is subject to inputs from
the ECONOMICS box, both in the form of the material resources Marxists are good
at analyzing, and the market processes seen by conventional economists. In the
past, Durkheimian theorists have tended to downplay conflict, and to regard the
POLITICAL box as little more than a place where the norms and ideals of society
are enacted.We need all four
boxes.

There are other important but
one-sided theories in the SOCIAL INTERACTION box. Freud and his followers were
especially imperialistic, applying the theoretical dynamics of early family life
to remote fields like art and politics. To his credit, Goffman said that
he was dealing with only one part of the puzzle.

The nearest to recognizing the
pervasiveness of multiple causality was Max Weber. In his theory of
stratification, he argued against Marx that there are not only economic
classes, but divisions by cultural life-style groups (status groups), and by
power groups or parties fighting over control of the field of state power.
Weberians have elaborated this into a 3-dimensional scheme, in which everything
has an economic, social/cultural, and political aspect. Weber merges the social
and ideological boxes, since he argues (especially in the history of religions)
that every kind of ideal has a social group that is its carrier.

The most important new development
of Weber’s 3-dimensional theory is Michael Mann, who elaborates it to four
dimensions in The Sources of Social Power.
Mann does this by splitting the POLITICAL box into political power (the
internal dynamics and penetration of the state), and military power.Mann thus analyzes world history as a
series of shifts in the four sources of power: Ideological, Economic,
Political, and Military.(The
Social Interaction box gets downplayed.) In Mann's theory, a major revolution must
include changes in at least three of these.

Origin of the Four-Requisites model

Sociologists who know the history
of our field will recognize that what I am saying is not original, but was
stated by Talcott Parsons.Since
Parsons was my undergraduate teacher at Harvard in the early 1960s, there is no
mystery about where I have gotten the four-requisites model.I have made two changes, one minor and
one major. Parsons had a much more abstract way of labeling the four boxes (he
called them Adaptation, Goal-attainment, Interaction, and Latent pattern
maintenance-- hence Parsonian students used to refer to them as the AGIL
scheme); and he referred to the four boxes as “pattern variables.”It is a lot easier to see what we are
talking about if we call them ECONOMIC, POLITICAL, SOCIAL INTERACTION, and
CULTURE boxes.

The major change is getting away
from functionalism. Parsons regarded society as like a biological organism, in
which all the parts are like organs that function harmoniously together to keep
the organism healthy. Functionalists have trouble dealing with conflict, since
there is no analogy in the physiological world. And their theoretical bias is
to see everything as contributing to the success of the social organism. I have
changed the model to four requisites for a social unit to succeed, without
assuming that the requisites will be met. As we have seen in examining
medicine, parties, and businesses, they often fail. And they are full of
internal dilemmas, so that one box works against the success of another.

The key is to treat everything as
a variable: how much and what kinds of material/economic resources, political
alliances and conflicts, networks and emotional solidarity, and ideas are
there? Our aim is to make the theory explain quantitative differences rather
than merely checking off a set of conceptual boxes. As I have suggested,
different kinds of social projects have different emphases among the four
requisites; and these requisites can change over its life-history.

One-sided theories are popular.
They have the practical advantage of making our cognitive world more
manageable; and they appeal to feelings of membership in some ideological movement
striving to dominate the intellectual world. Their disadvantage is that
one-sided theories always fail through their blind spots.

The four-requisites model is a
convenient way of dealing with the multi-causal processes that make up the real
world. Combining the best theories in each of the four boxes is our most
realistic way of explaining what will make anything succeed or fail.

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